Background/Purpose: A rapid loss of bone mass and an increase in fractures have been described in the first six months after liver transplantation. This phenomenon occurs in patients with a previous diagnosis of osteoporosis, but also in those with normal bone mass. Several factors, such as corticosteroids and others, may explain the increased risk of fractures. Treatment with bisphosphonates may help halt bone loss, improve lumbar bone mass, and reduce fractures. This study aims to evaluate characteristics, bone health, and risk of fracture of patients included in the liver transplantation pre-assessment at a tertiary center. Also, to ascertain the indication for antiresorptive therapy and the development of bone complications after transplantation.

Methods: A descriptive cross-sectional study of patients enrolled for a multidisciplinary assessment before liver transplantation from February 2019 to March 2021, with a follow-up of 6 and 12 months after transplantation. Sex, age, body mass index (BMI) and alcohol and tobacco consumption were collected. DXA-based osteopenia or osteoporosis diagnoses, the number of bone fragility fractures, and radiographic vertebral fractures were evaluated. FRAX index adapted for the Spanish population was calculated to estimate the 10-year risk of major osteoporotic fracture and hip fracture. Additionally, the indication for antiresorptive treatment and the occurrence of clinical fracture after liver transplantation were registered. Categorical variables are expressed as frequencies and percentages, and continuous variables with normal data distribution, as mean and standard deviation (SD).

Results: A total of 97 patients (77.3% men) were included, with a mean age of 60 years (SD 7.5) and a mean BMI of 28.2 kg/m² (SD 4.8). 68% were smokers, and 72% had a background of moderate-severe alcohol consumption. 3.1% presented a fragility fracture, and in 15.5%, a vertebral fracture was diagnosed as seen by radiography. 58.8% had osteopenia, and 30.9% osteoporosis by DXA. 91% had a deficiency of 25-OH vitamin D (< 30 ng/ml). The mean 10-year risk of major fracture was 3.9% (SD 3) and 1.6% (SD 2.1) for hip fracture. Lastly, 31 (32.0%) would meet treatment criteria according to FRAX scores, DXA results and background of fragility fractures (Table). Adding osteopenia as a criterion for initiating antiresorptive therapy, the number of patients candidates was 75 (77.3%). 66 (68%) finally received treatment (52.6% with IV zoledronate). In the follow-up, 50 received liver transplantation. Twenty-one of them has been followed six months and 17 a year. Two patients have developed a clinical fracture (one case of L2 fracture at five months, and the other a hip fracture at nine months), despite treated at baseline with bisphosphonates.

Conclusion: In this study, many candidates for liver transplantation candidates showed risk factors for the development of fragility fractures, but half of the patients who received antiresorptive drugs would not meet the usual criteria for treatment. Nonetheless, the risk of fracture in the months after transplantation supports the need to optimize bone mineral treatment and to carry out close follow-up.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/osteoporosis-assessment-and-outcomes-in-candidates-for-liver-transplantation-in-a-tertiary-center/